Head lice A Randomised Controlled Trial

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Head lice A Randomised Controlled Trial

• Comparing the effectiveness of traditional head
  lice lotion with the bug-busting method of
  managing head lice infestation.
• L Plastow, M Luthra, M Marshall,
• D Russell, J Wright.
• Mt. Pleasant Health Centre, Exeter.
• R Powell, Exeter N.Devon RDSU

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Aim

• To compare the effectiveness of
• traditional head lice lotion
• (phenothrin) with the bug-busting
• method of managing head lice
• infestation

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Intervention versus control

• Control Group
• Phenothrin
• Smell
• Tolerability
• Application

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Intervention versus control

• Intervention Group
• Bug-busting Pack
• C.H.C.
• Combs
• Conditioner

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Context

• Setting Two semi-rural General Practices in East
  Devon
• Participants 30 children aged 4-16 years
  randomly assigned to the two intervention groups
  phenothrin and bug-busting
• Ethical approval granted by Exeter Ethics
  Committee
• Funding Northcott Foundation

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Rationale

• Incidence
• Reluctance by parents to use traditional lotions
• Trust policy- no evidence base
• Cost
• Changing role of school nurse

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Participants

• 1. Recruitment school, G.P., Pharmacy
• 2. Randomisation-children chose sealed envelopes
• 3. Parents and siblings data included only if
  criteria met

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Exclusion Criteria

• Active symptomatic asthma
• Persistent skin disorder of scalp
• Treated with head lice lotion within previous 4
  weeks
• Hair bleached, permed, coloured
• Sensitivity to pyrethroid, organophosphate and or
  carbon insecticides
• Sensitivity to chrysanthemums

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Baseline Characteristics
No with infested siblings in the same household
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Main Outcome Measure

• Absence of live lice at Day 14

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(No Transcript)
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Intervention

• Control Group
• Day 1- Combed dry.
• Lice found stuck on CRF. Lotion applied
• Day 4- no intervention
• Day 7 as Day 1
• Day 10- no intervention
• Day14 Combed dry.
• Lice removed stuck on CRF

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Intervention

• Intervention Group
• Day 1- Combed dry. Lice found stuck on CRF.
  Conditioner applied. Combed using BBP
• Day 4- Conditioner applied. Combed using BBP
• Day 7 as Day 1
• Day 10- as Day 4
• Day 14 Combed dry. Lice removed stuck on CRF

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Statistical Analysis

• Intention to treat analysis was conducted using
  Mann Whitney U test (Non-parametric) for
  continuous data.
• Where there was no evidence of skewness,
  Chi-squared was conducted for categorical data

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Results

• Day 1
• Children in BBP infested with median of 8 lice at
  any stage in development compared with a median
  of 10 in the lotion group.
• This difference was not significant (pgt.05).

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Day Seven Results

• Children in BBP were infested with a median of 3
  lice at any stage in development compared with a
  median of 15 in the lotion group.
• This difference was significant (p0.041)

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Day Fourteen Results

• Children in BBP were infested with a median of 0
  lice at any stage in development compared with a
  median of 5 in the lotion group.
• This difference was significant (p0.008)

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Results
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Key Findings

• Intervention Group
• Cumulative body count on days 1,7, 14 466
• Reducing body count as a result of effective BB
  Intervention

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Key Findings

• Control Group
• Cumulative body count on days 1,7, 14 1028
• Increasing body count as a result of egg hatching
  and reproduction of lice not killed by lotion
  application

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Key Findings

• Intervention Group
• At Day 7 the number of living nymphs was 218
  (47)
• At day 14 the number of living nymphs was 29 (6)
  (plt0.001)

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Key Findings

• Control Group
• At Day 7 the number of living nymphs was 462
  (45)
• At day 14 the number of living nymphs was 280
  (27) (plt0.001)

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Summary

• NNT 2.5 (95 CI 2.19 to 2.81)
• A minimum of two applications of lotion required
  for clinical effectiveness
• The BBP method is likely to be more effective
  than traditional methods